In a speech delivered to Congress Wednesday, President Joe Biden again mentioned the importance of providing care to seniors in their own homes. Specifically, he touted his administration’s previously announced American Jobs Plan, which would include $400 billion for home-based care. Much of that money… Read More »In Speech to Congress, President Biden Again Shines Spotlight on Home-Based Care
Can’t see the audio player? Click here to listen on SoundCloud. It’s been a busy 100 days for the Biden administration on health policy. The promise Joe Biden made as president-elect to get 100 million covid vaccinations in arms was doubled, healthcare.gov reopened to those without… Read More »KHN’s ‘What the Health?’: 100 Days of Health Policy
Votive Health — a technology startup that facilitates payer-provider integration — formally announced its launch and first funding round on Wednesday. The company raked in $2.5 million in a round led by Flare Capital Partners, with Chrysalis Ventures and OCA Ventures as co-investors. San Luis… Read More »Votive Health Raises $2.5M to Help Home-Based Care Providers Make Value-Based Arrangements
COVID-19 Deaths and Cases in Long-Term Care Facilities Have Fallen to All-Time Lows in the Four Months Since Vaccinations Began
COVID-19 deaths and cases among residents and staff of long-term care facilities have fallen dramatically since vaccinations began in December, with deaths declining by nearly 89 percent and cases declining by nearly 92 percent as of April 2021, according to a new KFF analysis. COVID-19… Read More »COVID-19 Deaths and Cases in Long-Term Care Facilities Have Fallen to All-Time Lows in the Four Months Since Vaccinations Began
COVID-19 Long-Term Care Deaths and Cases Are at An All-Time Low, Though A Rise In LTC Cases In A Few States May Be Cause for Concern
This data note looks at state-reported LTCF data from 41 states plus Washington DC to assess what has happened to new deaths and cases in LTCFs in the four months since vaccinations began on December 21st, 2020. We also examine how recent changes in deaths… Read More »COVID-19 Long-Term Care Deaths and Cases Are at An All-Time Low, Though A Rise In LTC Cases In A Few States May Be Cause for Concern
What Are Some Policy Options for Reaching the 2.2 Million Uninsured People in the ACA’s “Coverage Gap”?
A new KFF issue brief explores several potential policy options that would help close the Affordable Care Act’s “coverage gap,” including providing further new incentives for states to expand Medicaid, creating a new “public option” or extending ACA Marketplace premium subsidies to low-income people who… Read More »What Are Some Policy Options for Reaching the 2.2 Million Uninsured People in the ACA’s “Coverage Gap”?
Can’t see the audio player? Click here to listen on SoundCloud. The Biden administration is speeding up the pace of efforts to undo Trump administration health policies. The two most recent: overturning a ban on fetal tissue research funded by the National Institutes of Health and… Read More »KHN’s ‘What the Health?’: Picking Up the Pace of Undoing Trump Policies
This issue brief examines some of the other options policymakers may consider to extend coverage to people in the gap, including increased fiscal incentives for states, a narrower public option, and making people with incomes below the poverty level eligible for enhanced ACA premium subsidies.
In the crowded home-based care market, providers have been forced to become increasingly more creative when it comes to their service offerings. One company, Accra, recently saw success with the growth of its unique financial management services program. The Minnetonka-based Accra is the largest provider… Read More »Why Minnesota’s Largest Home Care Provider Doubled Down on Financial Management Services
Facing a yearlong siege from the coronavirus, the defenses in another, older war are faltering. This story also ran on NPR. It can be republished for free. For the last two decades, HIV/AIDS has been held at bay by potent antiviral drugs, aggressive testing and… Read More »Strides Against HIV/AIDS Falter, Especially in the South, as Nation Battles Covid
This issue brief places the American Jobs Plan in the context of current Medicaid HCBS spending and considers how policymakers might allocate the new funding, as the proposal to date includes little detail.
Can’t see the audio player? Click here to listen on SoundCloud. The effort to vaccinate Americans against covid-19 took a hit this week. The Centers for Disease Control and Prevention and the Food and Drug Administration jointly called for a pause in use of the vaccine… Read More »KHN’s ‘What the Health?’: Pause and Effect on Covid Vaccines
The long and winding saga behind the Medicare sequestration holiday for home health providers and others has come to a close. On Tuesday, the U.S. House of Representatives overwhelmingly voted by a 384-38 margin in favor of a continued sequestration delay. The legislation was one… Read More »Biden, Congress Extend Medicare Sequestration Holiday Through 2021
Dr. John Frownfelter, MD, FACP, Chief Medical Officer at Jvion In 1852, Mercy Hospital & Medical Center opened as Chicago’s first chartered hospital. In May, it will close, leaving residents of the surrounding South Side community — poor and mostly people of color — without… Read More »What Will It Take for Hospitals to Survive the Pandemic?
As part of its ongoing effort to improve maternal outcomes in the country, the government has approved Illinois’ request to extend full Medicaid coverage for new mothers. The approval extends the coverage from 60 days to one year and will give about 2,500 women living… Read More »Illinois first state to offer full Medicaid benefits to women one year postpartum
Home-based care insiders have been saying for a long time what a wider group of people are now: Care needs to be brought into the home more frequently — and quickly. But accomplishing that won’t be so simple. In fact, turning the nation’s long-term care… Read More »‘There Is Not An Easy Solution’: How to Modernize Home- and Community-Based Services
There’s widespread agreement that it’s important to help older adults and people with disabilities remain independent as long as possible. But are we prepared to do what’s necessary, as a nation, to make this possible? This story also ran on NPR. It can be republished… Read More »Biden Seeks $400 Billion to Buttress Long-Term Care. A Look at What’s at Stake.
Jessica Scruton, BSN, RN, CCM, VP of Clinical Transformation for Lightbeam Health Solutions COVID-19 forced many health systems to reassess and reconfigure their care management processes and staffing models so that clinicians could better manage more of their acute, complex, and otherwise healthy patients remotely… Read More »Time and Goals Should Drive Your Post-COVID-19 Care Management Strategy
Can’t see the audio player? Click here to listen on SoundCloud. Health care makes some surprising appearances in President Joe Biden’s $2 trillion infrastructure plan, even though more health proposals are expected in a second proposal later this month. The bill that would help rebuild roads,… Read More »KHN’s ‘What the Health?’: Health Care as Infrastructure
This data note looks at national and state-by-state Medicaid and CHIP enrollment data through November 2020, as states were still in the early stages of experiencing the health and economic effects of the coronavirus pandemic. After declines in enrollment from 2017 through 2019, preliminary data… Read More »Analysis of Recent National Trends in Medicaid and CHIP Enrollment
Centene has rebutted the accusations made in a sealed lawsuit filed by the Ohio attorney general that accused the insurer of over-billing the state’s Medicaid department. The lawsuit is based on a misunderstanding of how Medicaid billing operates and should be unsealed, Centene said.
‘There Are Still Many Questions Unanswered’: Home Care Providers Seek Clarity on American Rescue Plan
As part of the recently passed $1.9 trillion American Rescue Plan, state Medicaid programs have seemingly received a major bump in funding for vital home- and community-based services (HCBS). In theory, the bump is designed to help HCBS operators expand their services, attract new workers… Read More »‘There Are Still Many Questions Unanswered’: Home Care Providers Seek Clarity on American Rescue Plan
It is hard to qualify for Medicaid as an adult in Missouri. Single adults aren’t eligible for coverage through the state’s program — dubbed MO HealthNet — at all, and parents can’t make more than 21% of the federal poverty level: $5,400 in 2021 for… Read More »Missouri ‘Voted for This Lie,’ Says State Rep Trying to Block Medicaid Expansion
Three-year-old Elizabeth Zakutansky was born with a rare genetic condition that causes multiple seizures. Her neurologist, a top expert on treating her condition, practices at Lurie Children’s Hospital of Chicago, less than an hour’s drive from the Zakutanskys’ home in Hobart, Indiana. Her parents would… Read More »Families With Sick Kids on Medicaid Seek Easier Access to Out-of-State Hospitals
Can’t see the audio player? Click here to listen on SoundCloud. Congress is out of session, but that hasn’t stopped Democrats from planning their next round of health legislation. Together with President Joe Biden, they are looking at a broad array of possibilities, from allowing Medicare… Read More »KHN’s ‘What the Health?’: Planning for Round Two
Peter Nelson, VP & General Manager, Global Alliances at GHX There’s an old adage that every challenge is merely an opportunity in disguise. COVID-19 highlighted the healthcare industry’s ongoing challenge with producing clean, standardized data. As the industry looks to rebound from the severe financial… Read More »Boost Operational, Clinical and Financial Performance with Good Data
Indiana’s Medicaid expansion — with its “personal responsibility” provisions that require enrollees to pay monthly premiums and manage health savings accounts — proved no better at improving health and access to care than other state expansions, a federally commissioned study found. Use Our Content It… Read More »Indiana’s Medicaid Expansion — Designed by Pence and Verma — Panned in Federal Report
President Joe Biden is trying to make good on one of his main campaign promises. The Biden administration on Wednesday unveiled a new $2 trillion infrastructure proposal to create jobs, build roads, fix bridges and more. On top of that, the proposal — officially dubbed… Read More »‘A Monumental Advance’: Newly Unveiled American Jobs Plan Would Invest $400B into Home-Based Care
The startup, which provides primary care services to Medicaid patients, plans to use the funds to expand into new states and add maternity and pediatrics services lines. It also recently launched a vaccination site in conjunction with the New York Department of Health.
Medicare Advantage beneficiaries spend $1,640 less per year on healthcare than those enrolled in traditional fee-for-service Medicare plans, a new report shows. But, despite the difference in savings, satisfaction levels for both types of plans are similar.
KHN has put together an interactive tool of significant health policies implemented by the Trump administration using its own authority — executive orders, agency guidance or formal regulations — and is tracking Biden administration and court actions. We will update this chart as actions are… Read More »The Great Undoing: Which of Trump’s Policies Will Biden Reverse?
Mark Prather MD, MBA, CEO & Co-founder at DispatchHealth The COVID-19 pandemic has transformed how we interact with one another, with businesses, and with the world around us. From social distancing to hand sanitation to remote working, its impact on society is immense. And among… Read More »How the Pandemic is Accelerating the Shift to Alternative Care Delivery Models
This brief explores issues related to risks related to COVID-19, vaccine priority in state plans, and other policy options that affect access to vaccines for people experiencing homelessness.
When Democrats pushed through a two-year expansion of the Affordable Care Act in the covid-relief bill this month, many people celebrated the part that will make health insurance more affordable for more Americans. This story also ran on NPR. It can be republished for free.… Read More »Democrats Gave Americans a Big Boost Buying Health Insurance. It Didn’t Come Cheap.
Can’t see the audio player? Click here to listen on SoundCloud. The covid relief bill signed by President Joe Biden a week ago includes billions of dollars in new health benefits for consumers. But those benefits may be hard for people to take advantage of because… Read More »KHN’s ‘What the Health?’: ACA Packs More Benefits — And More Confusion
An innovative care concept designed to keep patients at home and out of skilled nursing facilities (SNFs) is reportedly gaining ground in Congress and among special interest groups. The concept — known as “Choose Home” — is a type of SNF-at-home model that leverages both… Read More »SNF-at-Home Concept Earning ‘Very Positive Feedback’ in Congress, Among Special Interest Groups
What You Should Know: – Unite Us, the tech company creating coordinated care networks nationwide, has just announced a $150M Series C round of funding led by ICONIQ Capital, bringing its valuation at $1.65 billion. – Unite Us is leading the care transformation movement towards whole-person health… Read More »Unite Us Nabs $150M, Reaching $1.6B Valuation to Address Social Determinants of Health
President Joe Biden’s goal of providing health care for more Americans advanced this week with his signing of an economic stimulus package that includes subsidies for health insurance premiums and new incentives for states to expand Medicaid, as well as the potential confirmation of Xavier… Read More »Analysis: The Trump Health Care Policies That Deserve to Stick Around
Rick Halton, Vice President of Marketing, Lumeon The COVID-19 pandemic made healthcare visits over video or phone the norm, likely turning telehealth into a permanent fixture within the U.S. healthcare system. In fact, the majority of patient access leaders at large hospitals believe 20-30 percent… Read More »Quality Virtual Care Matters for Patients – Even More Than Telehealth
CMS has increased the Medicare payment rate to $40 for administering single-dose Covid-19 vaccines and $80 for two-dose vaccines. The payment increase aims to support providers as they ramp up vaccine administration.
Potential Impact of Additional Federal Funds for Medicaid HCBS for Seniors and People with Disabilities
The American Rescue Plan includes a provision to increase the federal matching rate (FMAP) for spending on Medicaid HCBS by 10 percentage points from April 1, 2021 through March 31, 2022 provided states maintain state spending levels as of April 1, 2021.This brief discusses the… Read More »Potential Impact of Additional Federal Funds for Medicaid HCBS for Seniors and People with Disabilities
The Ohio attorney general has filed a lawsuit alleging that a Centene subsidiary, which provides Medicaid services in the state, hired multiple companies to administer pharmacy benefits in order to inflate costs. As a result, the state’s Medicaid department paid millions in overcharges.
Help at Home has a new CEO. The home- and community-based services provider announced Monday that current board member Chris Hocevar has been appointed chief executive officer, effective immediately. Hocevar replaces Paul Mastrapa, who previously served as a consultant and as the leader of Option… Read More »PE-Backed Help at Home Names New CEO
Medicaid Spending and Enrollment Trends Amid the COVID-19 Pandemic – Updated for FY 2021 & Looking Ahead to FY 2022
Even as the COVID-19 vaccine roll-out is accelerating across the country, the public health and economic effects of the pandemic continue to put pressure on Medicaid spending and enrollment. In mid-February 2021, the Kaiser Family Foundation (KFF) and Health Management Associates (HMA) fielded a two-part… Read More »Medicaid Spending and Enrollment Trends Amid the COVID-19 Pandemic – Updated for FY 2021 & Looking Ahead to FY 2022
As of February 2021, there are three COVID-19 vaccines approved for emergency use in the U.S. and states are playing a central role in their timely distribution and prioritizing eligible populations. Because Medicaid covers for over 77 million enrollees, including groups disproportionately at risk of… Read More »A Look at How Medicaid Agencies Are Assisting with the COVID-19 Vaccine Roll-Out
Can’t see the audio player? Click here to listen on SoundCloud. For the first time since its enactment in 2010, the Affordable Care Act is slated for major benefit expansions, courtesy of the covid relief bill approved by Congress this week. But the changes are only… Read More »KHN’s ‘What the Health?’: Expanding the ACA in an Unpredicted Way
Addus HomeCare Corporation (Nasdaq: ADUS) — the personal care services powerhouse that has increasingly turned its attention to home health and hospice care over the past few years — has inked a new value-based care deal. The Frisco, Texas-based in-home care company announced Wednesday that… Read More »Addus Enters Value-Based Care Deal with Presbyterian Health Plan
More than half of those who received their first dose of a COVID-19 vaccine through a community health center were people of color, suggesting that health centers appear to be doing a better job of reaching people of color than are overall vaccination efforts, finds… Read More »Early COVID-19 Vaccination Efforts Through Community Health Centers Are Reaching People of Color
Medicaid and CHIP Eligibility and Enrollment Policies as of January 2021: Findings from a 50-State Survey
This report provides data on state Medicaid and CHIP eligibility levels and presents a snapshot of key aspects of state enrollment and renewal procedures in place during the COVID-19 PHE based on information from the 19th annual survey of Medicaid and CHIP program officials in… Read More »Medicaid and CHIP Eligibility and Enrollment Policies as of January 2021: Findings from a 50-State Survey
A new startup has entered the highly competitive insurtech market — with $50 million in new funds. Circulo, co-founded by Olive CEO Sean Lane, is a Medicaid managed care company that plans to build a platform to improve care delivery and member experience.
KFF Tracking Poll: More Than a Third of Americans Say They’ve Struggled to Pay Living Expenses Since December; 6 in 10 Families Hit by COVID Have Lost A Job or Income
Majorities Favor Provisions to Expand Marketplace Tax Credits and Encourage States to Expand Medicaid As Congress considers an additional $1.9 trillion COVID-19 relief plan, more than a third (37%) of Americans say that someone in their household has had trouble paying basic living expenses over… Read More »KFF Tracking Poll: More Than a Third of Americans Say They’ve Struggled to Pay Living Expenses Since December; 6 in 10 Families Hit by COVID Have Lost A Job or Income
This poll examines the public’s assessments of the Biden administration’s handling of the coronavirus pandemic, the impact COVID-19 has had on people’s finances, and support for provisions of the latest COVID-19 relief bill. It examines the public’s views of the ACA and possible next steps.
Many Nonelderly People With Disabilities Face COVID-19 Risks Similar to Those of the Elderly in Nursing Homes, But Do Not Have Equal Footing When it Comes to Vaccine Priority
While the toll of COVID-19 on nursing home residents has been well documented, less noticed has been the experience of nonelderly people with disabilities who rely on long-term care services and supports outside of nursing homes. In many ways the two groups face similar health… Read More »Many Nonelderly People With Disabilities Face COVID-19 Risks Similar to Those of the Elderly in Nursing Homes, But Do Not Have Equal Footing When it Comes to Vaccine Priority
This issue brief presents current state-level data about COVID-19 cases and deaths in settings that primarily serve nonelderly people with disabilities and summarizes available research on this population’s elevated risk of severe illness and death; explains how nonelderly people with disabilities and their LTSS providers… Read More »COVID-19 Vaccine Access for People with Disabilities
This brief takes a closer look at multiple measures beyond waiver waiting lists to evaluate state choices about optional Medicaid eligibility pathways, spending, and services for seniors and people with disabilities as of 2018. The analysis draws on several KFF resources, including 50-state surveys of… Read More »State Variation in Medicaid LTSS Policy Choices and Implications for Upcoming Policy Debates
OBGYNs and the Provision of Sexual and Reproductive Health Care: Key Findings from a National Survey
This report highlights key findings from the 2020 KFF National Physician Survey on Reproductive Health that asked a nationally representative sample of OBGYNs practicing in the United States about a wide range of issues, including their provision of contraception, abortion, and STI care.
Montana is considering becoming the latest state to intensify its hunt for welfare overpayments and fraud, a move expected to remove more than 1,500 enrollees from low-income health coverage at a time when the pandemic has left more people needing help. With Republicans now controlling… Read More »With GOP Back at Helm, Montana Renews Push to Sniff Out Welfare Fraud
This issue brief explores the impact of COVID-19 on justice-involved populations, examines how states have prioritized these populations for vaccination, and highlights the significance of Medicaid coverage for this population as well as proposals to expand access to Medicaid coverage.
Ford Blakely, SVP & GM, Medallia Zingle Although the vaccine’s rollout is slowly underway, Covid cases worldwide are continuing to reach all-time highs as new mutations make the virus even more contagious than ever before. Not surprisingly, patients’ concerns about visiting their healthcare providers in… Read More »3 Ways to Boost Patient Confidence with Real-Time Contactless Communication
Can’t see the audio player? Click here to listen on SoundCloud. An estimated 9 million Americans eligible for free or reduced premium health insurance under the Affordable Care Act have a second chance to sign up for 2021 coverage, since the Biden administration reopened enrollment on… Read More »KHN’s ‘What the Health?’: Open Enrollment, One More Time
Two New Analyses: House COVID-19 Relief Plan Would Temporarily Lower Marketplace Premiums for Millions and More than Offset Short-Term State Costs to Expand Their Medicaid Programs
The House COVID-19 relief proposal would temporarily lower what millions of Marketplace enrollees and uninsured potential enrollees would pay toward premiums and would provide states that have not expanded their Medicaid programs a financial boost that would more than offset their costs initially, two new… Read More »Two New Analyses: House COVID-19 Relief Plan Would Temporarily Lower Marketplace Premiums for Millions and More than Offset Short-Term State Costs to Expand Their Medicaid Programs
The House Energy and Commerce Committee reconciliation proposal as part of the COVID relief package aims to encourage non-expansion states to take up the expansion by providing an additional temporary fiscal incentive for states to newly implement the ACA Medicaid expansion. This brief provides illustrative… Read More »New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending
What You Should Know: – Health Current, Arizona’s health information exchange (HIE), today announced the selection of NowPow as the vendor of choice for Arizona’s closed-loop referral system (CLRS) to address social determinants of health (SDOH) needs in Arizona. – By connecting healthcare and community… Read More »Arizona to Implement a Statewide Social Determinants of Health Closed Loop Referral System
President Joe Biden has an unexpected opening to cut deals with red states to expand Medicaid, raising the prospect that the new administration could extend health protections to millions of uninsured Americans and reach a goal that has eluded Democrats for a decade. The opportunity… Read More »Why Biden Has a Chance to Cut Deals With Red State Holdouts on Medicaid
Though the Trump Administration has left office, the Supreme Court is set to decide whether Medicaid work requirements – a controversial policy advanced by the Trump Administration – are legal.
To provide context to the current landscape of Medicaid and work, this brief explores work status and characteristics of Medicaid enrollees as well as perspectives from enrollees who participated in focus groups prior to the pandemic.
Can’t see the audio player? Click here to listen on SoundCloud. President Joe Biden has said he still wants a bipartisan bill to provide the next round of covid relief. But in case that doesn’t happen, House committees this week got down to work on a… Read More »KHN’s ‘What the Health?’: All About Budget Reconciliation
President Biden’s January 28th executive order to reopen enrollment in the federal ACA Marketplace from February 15 through May 15, combined with $50 million in federal spending on outreach and education about ACA coverage options, has the potential to reach millions of people who were… Read More »ACA Open Enrollment Matters for Medicaid Coverage, Too
Two in-home care providers — ConcertoHealth and Perfect Health — announced Wednesday that their organizations have merged. Together, the companies will operate under the name “ConcertoCare.” Aliso Viejo, California-based ConcertoHealth is a value-based care provider organization that delivers a variety of home-based care services. The… Read More »In-Home Care Providers ConcertoHealth, Perfect Health Merge to Form ‘ConcertoCare’
The two-page fact sheets provide a snapshot with key data for those who would become eligible for Medicaid under expansion in non-expansion states.
What You Should Know: – Anthem, Inc. has entered into an agreement with InnovaCare Health, L.P., to acquire its Puerto Rico-based subsidiaries, including MMM Holdings, LLC (“MMM”) and its Medicare Advantage (MA) plan MMM Healthcare, LLC as well as affiliated companies and Medicaid plan. … Read More »Anthem Acquires Puerto Rico’s Largest Medicare Advantage Plan
For many patients with complex and chronic conditions, high out-of-pocket costs for medicines pose a significant challenge. Recent research revealed a broken insurance system that fails to help those who need care most. New resources further demonstrate how patients with asthma, diabetes, HIV and cancer… Read More »Insurers shift medicine costs to patients with severe chronic illnesses
Self-directed home care services are on the rise. Last year, many states created even more Medicaid flexibilities to allow seniors to essentially hire their own family members as their caregivers, which was especially helpful amid stay-at-home orders and fears surrounding COVID-19. On their end, states… Read More »Use of Self-Directed Home Care Services Jumped 20% in 2020
What You Should Know: – Humana Inc. and DispatchHealth, a provider of in-home medical care, today announced an agreement to provide Humana members with access to an advanced level of care in the home – to help enhance patients’ experience and health outcomes. The Dispatch-Humana… Read More »Humana Taps DispatchHealth to Power Hospital-Level Care in the Home
Prior to its departure from office, the Trump Administration approved Tennessee’s request for a demonstration to change how the state’s Medicaid program operates, and more importantly, how vulnerable patients access the health care they need.
With the inauguration of President Biden and Democrats holding a slim majority in Congress, policymakers are likely to consider whether and how to reverse various health policy regulations issued by the Trump Administration.
Can’t see the audio player? Click here to listen on SoundCloud. Thursday was “health day” in President Joe Biden’s sprint to launch his presidency, and he signed two executive orders addressing health coverage and women’s reproductive rights. The orders will reopen enrollment under the Affordable Care… Read More »KHN’s ‘What the Health?’: The Long Road to Unwinding Trump Health Policies
This data note discusses changes in the number of applications for Medicaid/CHIP coverage during the coronavirus pandemic. Although enrollment in Medicaid/CHIP has increased steadily by more than 6 million individuals (9%) from February to September 2020, the total number of Medicaid/CHIP applications has decreased by… Read More »Analyzing Recent Trends in Medicaid/CHIP Applications: What We Do and Do Not Know
Chris Riopelle, CEO of Strive Health After an unprecedented year, kidney care providers, including nephrologists, dialysis facilities, and care extenders are expecting 2021 to follow suit. We will see an overhaul in reimbursement and major industry shifts, partly led by CMS, that will require providers… Read More »Why CMS Will Lead the 2021 Kidney Care Revolution
As a result of the COVID-19 Public Health Emergency (PHE) , states have experienced increased enrollment along with administrative challenges. After the PHE ends, states are likely to have renewal and redetermination backlogs and will face decisions around continuing temporary policy changes. This brief highlights… Read More »Key Issues for State Medicaid Programs When the COVID-19 Public Health Emergency Ends
This issue brief takes a close look at Section 1115 waiver activity in the final days of the Trump Administration, including approval of Tennessee’s TennCare III program, to understand implications for the Biden Administration.
In states that do not implement the Medicaid expansion under the Affordable Care Act (ACA), many adults will fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits. Nationwide, 2.2 million poor… Read More »The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid
This data note looks at national and state-by-state Medicaid and CHIP preliminary enrollment data through September 2020, as states were still in the early stages of experiencing the health and economic effects of the coronavirus pandemic. After declines in enrollment from 2017 through 2019, preliminary… Read More »Analysis of Recent National Trends in Medicaid and CHIP Enrollment
The telehealth company and managed care organization are launching a new HMO plan on the Texas health insurance exchange. The ‘virtual-first’ plan is designed for those who do not qualify for Medicaid or Medicare.
As the Biden Administration takes office, the ongoing effects of the coronavirus pandemic and related economic downturn are the key issues that will substantially shape Medicaid coverage and financing policy in the year ahead.
Can’t see the audio player? Click here to listen on SoundCloud. The reverberations from the Jan. 6 storming of the U.S. Capitol by supporters of President Donald Trump continue. A broad array of business groups, including many from the health industry, are halting contributions to Republicans… Read More »KHN’s ‘What the Health?’: On Capitol Hill, Actions Have Consequences
Despite Efforts to Slow the Spread of the Virus in Long-Term Care Facilities, KFF Analysis Finds Many States Experienced the Worst COVID-19 Outbreaks and Highest Number of Deaths in December
For some regions of the country, recent months have brought the worst COVID-19 outbreaks in long-term care facilities since the start of the pandemic, a new KFF analysis of state-reported cases and death shows, underscoring the importance of current efforts to vaccinate this high priority… Read More »Despite Efforts to Slow the Spread of the Virus in Long-Term Care Facilities, KFF Analysis Finds Many States Experienced the Worst COVID-19 Outbreaks and Highest Number of Deaths in December
Factors Associated With COVID-19 Cases and Deaths in Long-Term Care Facilities: Findings from a Literature Review
This issue brief reviews findings from 30 studies that have examined potential factors associated with COVID-19 cases and/or deaths in long-term care facilities.
This analysis assesses when new LTCF cases and deaths were highest in states across the country in 2020, as well as how national trends in LTCF COVID-19 cases/deaths compare to national trends in overall COVID-19 cases/deaths in 2020.
Dr. Gary Call, Chief Medical Officer at HMS As healthcare spending continues to rise, so too does the inherent risk for bad actors to take advantage. Today, the United States is estimated to spend nearly 18 percent of its GDP, or $3.6 trillion, on healthcare,… Read More »Provider Strategies for Mitigating Telehealth Fraud & Abuse in 2021
Despite concerns over broadband access and reimbursement, telehealth still brings many opportunities to care for patients covered by Medicare and Medicaid, panelists said at CES.
This factsheet reviews major sources of coverage for women residing in the U.S. in 2019, discusses the impact of the ACA on women’s coverage, and the coverage challenges that many women continue to face
What You Should Know: – Net Health acquires post-acute market analytics platform PointRight to deepen the company’s analytics capabilities, post-acute presence, and support for SNF networks. Net Health, a provider of cloud-based software for specialty medical providers across the continuum of care, today announced that… Read More »Net Health Acquires Post-Acute Analytics Platform PointRight – M&A
This issue brief analyzes enrollment and spending trends related to the Affordable Care Act’s Medicaid expansion ahead of the coronavirus pandemic and examines potential consequences of recent enrollment increases.
Illinois and Chicago officials are trying to figure out how to stop a private company from closing a money-losing urban hospital in a poor, underserved Chicago neighborhood. Trinity Health, a national Catholic tax-exempt chain, wants to close Mercy Hospital and Medical Center on Chicago’s Near… Read More »An Urban Hospital on the Brink Vs. the Officials Sworn to Save It
USE OUR CONTENT It can be republished for free. SACRAMENTO, Calif. — The coronavirus pandemic doomed Gov. Gavin Newsom’s ambitious plans last year to combat homelessness, expand behavioral health services and create a state agency to control soaring health care costs. But even as the… Read More »California Budget Reflects ‘Pandemic-Induced Reality,’ Governor Says
With the Georgia runoff elections giving Democrats control of the U.S. Senate, Drew Altman discusses President-elect Biden’s potential health care agenda and suggests that the Centers for Medicare & Medicaid Services could have an expanded role and that it may be time to rename it… Read More »Joe Biden’s New Health Care Agenda (and CMS’s Big Role In It)
Use Our Content It can be republished for free. With just a dozen days left in power, the Trump administration on Friday approved a radically different Medicaid financing system in Tennessee that for the first time would give the state broad authority in running the… Read More »Trump Administration Approves First Medicaid Block Grant, in Tennessee
What You Should Know: – COVID-19 care deferrals lead to three major boomerang conditions that payers and providers must proactively address in 2021, according to a newly released report by Prealize. – COVID-19’s hidden victims—those who avoided or deferred care during the pandemic—will increasingly return… Read More »COVID-19 Deferrals Lead to 3 Major Conditions Payers/Providers Must Address in 2021
Como jefa de enfermería en uno de los hospitales más concurridos de la red de seguridad de atención médica de Chicago, Raquel Prendkowski ha sido testigo del devastador número de víctimas que COVID-19 ha causado entre los residentes más vulnerables de la ciudad, incluyendo a… Read More »Illinois, primer estado en ofrecer cobertura médica a adultos mayores indocumentados
In this column for the JAMA Health Forum, Larry Levitt explores what President-elect Biden might do to advance his health care vision both through legislation and through executive orders and waivers and demonstrations.
As a nurse manager for one of Chicago’s busiest safety-net hospitals, Raquel Prendkowski has witnessed covid-19’s devastating toll on many of the city’s most vulnerable residents — including people who lack health insurance because of their immigration status. Some come in so sick they go… Read More »Illinois Is First in the Nation to Extend Health Coverage to Undocumented Seniors
January 14 Web Event: A Shot in the Arm For Long-Term Care Facilities? Early Lessons from the COVID-19 Vaccine Rollout to High Priority Populations
With the pandemic taking a heavy toll among older Americans, the Centers for Disease Control and Prevention and most states have placed a high priority on vaccinating residents and staff of long-term care facilities. People in nursing homes and other long-term care settings account for… Read More »January 14 Web Event: A Shot in the Arm For Long-Term Care Facilities? Early Lessons from the COVID-19 Vaccine Rollout to High Priority Populations
Ted Howard started taking Truvada a few years ago because he wanted to protect himself against HIV, the virus that causes AIDS. But the daily pill was so pricey he was seriously thinking about giving it up. Under his insurance plan, the former flight attendant… Read More »Many Health Plans Now Must Cover Full Cost of Expensive HIV Prevention Drugs
Dr. Paul Hain, Chief Medical Officer of GoHealth Telehealth is Here to Stay in 2021 Prior to the pandemic, telehealth was a limited ad-hoc service with geographic and provider restrictions. However, with both the pandemic restrictions on face to face interactions and a relaxation of… Read More »12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup
As we close out the year, we asked several healthcare executives to share their predictions and trends for 2021. Kimberly Powell, Vice President & General Manager, NVIDIA Healthcare Federated Learning: The clinical community will increase their use of federated learning approaches to build robust AI models across various… Read More »30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021
The insurer picked digital health startup Vida to offer a virtual diabetes management program for Medicaid patients in Kentucky.
With President-elect Joe Biden and a new Congress taking office next month, newly updated KFF briefs examine two women’s health policy issues awaiting federal policymakers in 2021. President-elect Biden campaigned on reversing the Trump Administration’s regulations for the Title X family planning program, which require… Read More »Two Women’s Health Policy Issues to Monitor in 2021
This data note looks at national and state-by-state Medicaid and CHIP preliminary enrollment data through August 2020, as states were still in the early stages of experiencing the health and economic effects of the coronavirus pandemic. After declines in enrollment from 2017 through 2019, preliminary… Read More »Analysis of Recent National Trends in Medicaid and CHIP Enrollment
Community Health Centers’ Role in Delivering Care to the Nation’s Underserved Populations During the Coronavirus Pandemic
In the midst of the coronavirus pandemic, community health centers are serving as public health responders, especially for medically underserved populations. Health centers are a national network of safety net primary care providers who provided care to nearly 30 million patients in 2019, and disproportionately… Read More »Community Health Centers’ Role in Delivering Care to the Nation’s Underserved Populations During the Coronavirus Pandemic
What You Should Know: – Humana Healthy Horizons™ in Kentucky announced it has selected Vida Health’s virtual diabetes management program to serve Kentucky’s Medicaid population. – Vida’s diabetes management program achieves lasting results for participants. Because chronic conditions like diabetes, obesity, and hypertension often occur simultaneously,… Read More »Humana Taps Vida Health to Power Virtual Diabetes Management for Kentucky’s Medicaid Population
Can’t see the audio player? Click here to listen on SoundCloud. COVID-19 was the dominant — but not the only — health policy story of 2020. In this special year-in-review episode of KHN’s “What the Health?” podcast, panelists look back at some of the biggest non-coronavirus… Read More »KHN’s ‘What the Health?’: 2020 in Review — It Wasn’t All COVID
Catherine Thomas: Co-Founder and VP, Customer Engagement, careMESH Peter Tippett MD, PhD: Founder and CEO, careMESH A recent Advisory Board briefing examined the annual Centers for Medicare & Medicaid Services (CMS) Readmission penalties. Of the 3,080 hospitals CMS evaluated, 83% received a penalty for payments to… Read More »For Better Patient Care Coordination, We Need Seamless Digital Communications
When it comes to clinical and operational efforts, COVID-19 has been at the forefront for most home-based care providers. With the public health emergency top of mind, it may be easy to forget that new federal technology requirements — electronic visit verification (EVV), in particular… Read More »Providers Scramble to Figure Out EVV as Implementation Date Inches Closer
This brief discusses Medicaid’s eligibility for pregnancy and postpartum care, gaps in coverage particularly in states that have not expanded Medicaid under the ACA, and several state and federal efforts to extend postpartum coverage to more women for a longer period of time.
The recent election of former Vice President Joe Biden as well as the on-going effects of the coronavirus pandemic and related economic downturn are the key issues that will substantially shape Medicaid policy over the next year.
Federal legislation provides a temporary increase in federal Medicaid matching rates to states conditioned on states providing continuous eligibility for existing enrollees and meeting certain other eligibility requirements. This brief provides an overview of these maintenance of eligibility (MOE) requirements, examines what happens when the… Read More »Medicaid Maintenance of Eligibility (MOE) Requirements: Issues to Watch
In this brief, we analyze third quarter data from 2018 to 2020 to examine how insurance markets performed financially through the end of September. Average margins remained relatively high compared to the same point in recent years, suggesting many insurers remained profitable even as non-COVID-related… Read More »Health Insurer Financial Performance Through September 2020
Anne Davis, Director of Quality Programs & Medicare Strategy at HMS A global health crisis has thrust us into a scenario in which lives quite literally depend on the ability to virtually connect. Telehealth has rapidly emerged as a vital tool, enabling continuity of care,… Read More »As Telehealth Surges, Are Seniors Being Left Behind?
Courtney Tesvich, VP of Regulatory at Nextech When 2020 began, no one anticipated that complying with the Merit-based Incentive Payment System (MIPS)—the flagship payment model of the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP)—would look so different halfway through the year.… Read More »Despite COVID-19: Providers Should Not Lose Sight of MIPS Compliance
CityBlock Health, a startup focusing on providing care to Medicaid and dual-eligible patients, raised $160 million in funding. The Alphabet-spinout plans to use the funds to reach more patients and build out its digital care offerings.
What You Should Know: – Cityblock Health, a transformative, value-based healthcare provider focused on improving healthcare outcomes for marginalized communities, today announced a $160M Series C round, bringing its total raised to $300M. – Cityblock is a care delivery trailblazer working to right the injustices… Read More »Cityblock Health Reaches $1B Valuation, Raises $160M to Address Systemic Healthcare Inequity
What You Should Know: – Elation Health, which provides an easy-to-use and affordable clinical technology platform for more than 7 million independent primary care clinicians serving 14M+ patients – including an EHR raises $40M in Series C funding from Al Gore’s sustainable investment firm, Generation… Read More »Elation Health Nabs $40M for Clinical-First Solution to Power Independent Primary Care
The Trump administration wants to require the Department of Health and Human Services to review most of its regulations by 2023 — and automatically void those not assessed in time. A proposed rule would require HHS to analyze within 24 months about 2,400 regulations —… Read More »Trump Plan May Set Clock Ticking on Many Health Rules — Setting Off Alarms
Findings from administrative data suggest that the decline in enrollment among employer-sponsored insurance was far less than overall declines in employment as of September, and that many who did lose their job-based coverage likely found a safety net in coverage through Medicaid or the ACA… Read More »How Has the Pandemic Affected Health Coverage in the U.S.?
What You Should Know: – San Francisco-based digital health startup Pair Team emerges out of stealth with $2.7M in seed funding backed by Kleiner Perkins, Craft Ventures, & YC. – Pair Team provides both a remote team and AI that automates workflows, provides infrastructure &… Read More »Pair Team Emerges Out of Stealth with $2.7M to Automate Primary Care Operations
Don Godbee Don Godbee, Mobile Solutions Architect at Stratix Don Godbee Telehealth and virtual care are not brand-new phenomena suddenly cobbled together as a rapid response to the onset of the COVID-19 pandemic, but the average US patient could be forgiven for thinking that it… Read More »Ensuring Telehealth Providers’ Virtual Care Dollars Make Sense
This brief outlines the potential health policy actions that President Biden could take using executive authority, based on campaign pledges, and actions that would reverse or modify regulations or guidance issued by the Trump Administration.
Shanti Wilson, Consultant, Freed Associates As if 2020 couldn’t be any more challenging for healthcare providers, new federal rules on interoperability and patient access, granting patients direct access to their healthcare data, begin taking effect this November and continue into 2022. These rules, while ultimately beneficial… Read More »5 Steps for Interoperability Excellence for Healthcare Providers
Use Our Content It can be republished for free. SACRAMENTO — California Democratic lawmakers so far have failed to convince Gov. Gavin Newsom that the state can afford to spend an estimated $2.6 billion a year to expand its Medicaid program to all unauthorized immigrants.… Read More »California Lawmakers to Newsom: Give All Immigrants Health Coverage
CommonHealth App Connects to 230 Health Systems to Share Health Data – including COVID Test and Vaccine Status
What You Should Know: – CommonHealth has connected to 230 health systems in the United States, allowing patients to gather, manage and share their health and test data, including COVID test and vaccination status. By the end of this month, CommonHealth will connect to more… Read More »CommonHealth App Connects to 230 Health Systems to Share Health Data – including COVID Test and Vaccine Status
Claudia Williams, CEO of Manifest MedEx When doctors know their patients have been to the hospital, they can act fast to provide needed support. Widespread use of hospital event notifications is associated with all kinds of health benefits, including a 10 percent decrease in readmissions… Read More »5 Myth-Busting New Hospital ADT Notification Requirements
The contracts are complicated and full of risks for drug companies. But there’s also a risk to steering clear of the arrangements — reduced or restricted access to a company’s medication.
This data note looks at state Medicaid managed care enrollment data through September 2020 to assess the impact of the COVID-19 pandemic and economic crisis on Medicaid enrollment. Data collected for 30 states show Medicaid managed care enrollment increased to 11.3% from March 2020 through… Read More »Growth in Medicaid MCO Enrollment during the COVID-19 Pandemic
Science and objective analysis need to be revived.
Millions of Americans without healthcare insurance could be eligible to get coverage for free, or nearly free, through financial assistance offered under the Affordable Care Act. But many who recently lost their employer-based coverage may not be aware of the options available to them.
Elizabeth Bierbower, Former President of Humana’s Group & Specialty Division Healthcare can achieve optimum efficiency when patients are at the center of care. When patients have the necessary information to navigate their care journey, they will choose the path to high-quality care at the lowest… Read More »COVID-19: How Can Payers Prepare for Mandates and Support Pandemic Relief Efforts
Amid the ongoing pandemic and high unemployment, this poste xamines how many uninsured people would be eligible for free health insurance during in a typical year, including those who qualify for Medicaid or for tax credits that cover the full cost of an ACA Marketplace… Read More »Millions of Uninsured Americans are Eligible for Free ACA Health Insurance
If you’ve been watching TV lately, you may have seen actor Danny Glover or Joe Namath, the 77-year-old NFL legend, urging you to call an 800 number to get fabulous extra benefits from Medicare. There are plenty of other Medicare ads, too, many set against… Read More »Medicare Open Enrollment Is Complicated. Here’s How to Get Good Advice.
On November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to the Medicaid managed care regulations which were proposed in November 2018. CMS previously finalized a major revision to these regulations in 2016. The November 2020 final rule is not a… Read More »CMS’s 2020 Final Medicaid Managed Care Rule: A Summary of Major Changes
On November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to the Medicaid managed care regulations which were proposed in November 2018. CMS previously finalized a major revision to these regulations in 2016. The November 2020 final rule is not a… Read More »CMS’s 2020 Final Medicaid Managed Care Rule: A Summary of Major Changes
With its choice of a new leader, the Florida Hospital Association has signaled that seeking legislative approval to expand Medicaid to nearly 850,000 uninsured adults won’t be among its top priorities. In October, Mary Mayhew became the association’s CEO. Mayhew, who led the state’s Medicaid… Read More »Florida’s New Hospital Industry Head Ran Medicaid in State and Fought Expansion
NEW YORK — Mike Angevine lives in constant pain. For a decade the 37-year-old has relied on opioids to manage his chronic pancreatitis, a disease with no known cure. But in January, Angevine’s pharmacy on Long Island ran out of oxymorphone and he couldn’t find… Read More »Patients Struggle to Find Prescription Opioids After NY Tax Drives Out Suppliers
Use Our Content It can be republished for free. Attorneys for GOP-controlled states seeking to kill the Affordable Care Act told the Supreme Court last week that at least some of the 12 million people who newly enrolled in Medicaid signed up only because of… Read More »Red States’ Case Against ACA Hinges on Whether They Were Actually Harmed by the Law
Prasad Dindigal, Vice President, Healthcare & Life Sciences, EXL. Over the past few months, primarily as a result of the COVID-19 pandemic, telehealth has gone from a “nice-to-have” to a “must-have” for healthcare providers. The surge of COVID-19 patients in the spring, coupled with “stay-at-home”… Read More »8 Ways Advanced Analytics Can Help You Decide If Telehealth Should Be Temporary or Permanent
This data note analyzes federal Medicaid outlays in federal fiscal year (FFY) 2020, before and during the COVID-19 pandemic. Both annual and month-to-month growth rates in federal Medicaid outlays increased during the second half of FFY 2020, reflecting the onset of the pandemic and enhanced… Read More »Federal Medicaid Outlays During the COVID-19 Pandemic
What You Should Know: – The American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). – The new Category I CPT codes and long descriptors for… Read More »AMA Unveils 2 Vaccine-Specific CPT Codes for Coronavirus Immunizations
Now with a 6-3 conservative majority, the nation’s highest court still seems reticent to throw out the Affordable Care Act altogether. If the law stays in place, it would be the foundation for many of President-elect Biden’s planned healthcare policies.
This brief provides a summary of Medicaid’s role for pregnant women and infants and current Medicaid initiatives to improve maternal and infant health.
‘Our Work Begins with Getting COVID Under Control’: What a Biden Administration Means for Home-Based Care
After one of the closest and most hotly contested campaigns in modern history, President-Elect Joe Biden addressed the nation on Saturday from an outdoor platform in Wilmington, Delaware. While it’s far too early to say what the first 100 days of a Biden administration will… Read More »‘Our Work Begins with Getting COVID Under Control’: What a Biden Administration Means for Home-Based Care
This data note looks at national and state-by-state Medicaid and CHIP preliminary enrollment data through July 2020, as states were still in the early stages of experiencing the health and economic effects of the coronavirus pandemic. After declines in enrollment from 2017 through 2019, preliminary… Read More »Analysis of Recent National Trends in Medicaid and CHIP Enrollment
Sin un ganador y sin saber todavía qué partido controlará el Senado, el futuro del sistema de salud de la nación también sigue siendo incierto. Lo que está en juego es si el gobierno federal desempeñará un papel más importante en el financiamiento y el… Read More »Sin presidente todavía, el futuro de la salud también sigue siendo incierto
Poor, elderly individuals who may qualify for both Medicaid (for being poor) and Medicare (for being elderly, blind, disabled or have ESRD). In these cases, Medicaid serves as a supplemental insurer, covering Medicare coinsurance and deductibles. The generosity of this supplemental coverage for so-called ‘dual-eligibles’… Read More »Dual Eligibles’ Medicaid Policy Database
This data note presents the latest state-level data about nonelderly Medicaid adults who have disabilities but do not quality for SSI and considers the implications for their continued coverage if the ACA expansion is invalidated by the Court.
States are trying to strengthen their hand over drug prices in light of stalled federal efforts and their own budget crunches. The wildcard is whether the efforts will survive legal scrutiny.
SACRAMENTO — For deep blue California, where first-in-the-nation health care proposals regularly flood the Democratic agenda, there could not be more at stake in the presidential race. If Republican President Donald Trump prevails, Democratic state lawmakers worry, they’ll be forced to scale back their ambitious… Read More »California’s Progressive — and Expensive — Health Care Ambitions Rely on Biden Win
The ongoing expansion of Medicare Advantage (MA), a federal minimum-wage hike and additional support for front-line health care workers during the COVID-19 public health emergency. These are just a few of the industry-shaping topics that home health insiders are following going into Election Day this… Read More »Perspectives: Home Health Insiders Sound Off on the 2020 Election
As the Trump administration reaches the end of its first term, this issue brief considers the landscape of approved and pending Section 1115 Medicaid demonstration waivers under this administration and how the November 2020 presidential election may impact this landscape.
Sen. Lindsey Graham has never been a fan of the Affordable Care Act — even though it’s helped dramatically lower the number of uninsured people in his home state of South Carolina. The Republican, who heads the Senate Judiciary Committee, attacked the law at the… Read More »Sen. Graham Complains That 3 Blue States Get a Third of ACA Funding
President Donald Trump entered office seeking a massive overhaul of the Medicaid program, which had just experienced the biggest growth spurt in its 50-year history. His administration supported repealing the Affordable Care Act’s Medicaid expansion, which has added millions of adults to the federal-state health… Read More »The Trump Medicaid Record: Big Goals, Yet Few Successes
What You Should Know: – Healthify in partnership with Algorex Health Technologies, announced the results of new social determinants of health (SDoH) population analysis of Excellus BlueCross BlueShield (BCBS) members. – SDoH are non-clinical conditions that significantly affect health outcomes. The analysis identified Excellus BCBS… Read More »Healthify, Algorex Health & Excellus BCBS Tap into SDoH Analytics to Address Social Disparities
The COVID-19 Pandemic Has Taken a Higher Toll on Nursing Homes with Relatively High Shares of Black or Hispanic Residents
Nursing homes with a relatively high share of Black or Hispanic residents are more likely to have had a resident die of COVID-19 than homes with lower shares of such residents, finds a new KFF analysis. Nationwide, 63 percent of nursing homes with a relatively… Read More »The COVID-19 Pandemic Has Taken a Higher Toll on Nursing Homes with Relatively High Shares of Black or Hispanic Residents
Michael A Greely, Co-Founder & General Partner at Flare Capital Partners This will be ugly and sad. Racism has cost this country $16 trillion over the last twenty years according to a recent Citigroup report. Much of this loss ($13 trillion) was attributed to discriminatory lending… Read More »COVID-19 Pandemic Further Exposes Systemic Racism…
This data note presents national data that shows that nursing homes with a high share of Black or Hispanic residents were more likely to have at least one coronavirus case, at least one COVID-19 death, and (among facilities with cases) more severe case outbreaks than… Read More »Racial and Ethnic Disparities in COVID-19 Cases and Deaths in Nursing Homes
The repeal of the ACA could mean loss of Medicaid coverage for up to 15 million that were enrolled in the ACA Medicaid expansion group prior to the COVID-19 pandemic; however, repeal could also mean significant changes to Medicaid prescription drug policy with implications for… Read More »What Happens to Medicaid Drug Policy if the ACA is Overturned?
Florida’s plan to import cheaper prescription drugs from Canada — designed by Gov. Ron DeSantis and endorsed by President Donald Trump — has tasted its first bitter pill. No private firms bid on Florida’s $30 million contract to set up and operate a drug importation… Read More »Florida Fails to Attract Bidders for Canada Drug Importation Program
Vanessa Kuhn, Director of Health Policy, PatientPing The Centers for Medicare and Medicaid Innovation (CMMI) created the Direct Contracting Model to expand opportunities for more diverse providers and healthcare organizations to participate in value-based care arrangements for Medicare fee-for-service (FFS) beneficiaries. The goal of the… Read More »CMS Direct Contracting Model Options for Value-Based Care
What You Should Know: – Unite Us, the tech company building coordinated care networks nationwide announced a significant expansion to its partnership with Nebraska Health Information Initiative (NEHII), a health information exchange, to six additional states. – This growing partnership aims to break down existing… Read More »Unite Us Expands Social Determinants of Health Platform to 6 States
Can’t see the audio player? Click here to listen on SoundCloud. For the first time in a long time, there is some good news about the coronavirus pandemic: Although cases continue to climb, fewer people seem to be dying. And there are fewer cases than expected… Read More »KHN’s ‘What the Health?’: A Little Good News and Some Bad on COVID-19
As the 2020 Election Day approaches, many candidates continue to focus on health care issues, including on the public health and economic response to COVID-19, the future of the Affordable Care Act, health care costs and abortion. To help reporters understand and cover these issues,… Read More »Health Policy Resources for Covering the 2020 Elections
After Nebraskans cast their vote for Medicaid expansion in 2018, the state is finally expanding coverage to more residents. As part of the state’s rollout, it split its expanded Medicaid plans into two tiers, with work and other requirements to access dental and vision coverage.
A Massachusetts-based home health company and its owners will pay millions of dollars to resolve allegations that they falsely billed the state’s Medicaid program, MassHealth. The home health company is Altranais Home Care LLC, located in Lowell. Massachusetts Attorney General Maura Healey announced Friday that… Read More »Home Health Provider to Pay $3.1M to Resolve Improper Billing Allegations
In recent weeks, the possible overturning of the Affordable Care Act (ACA) in court and the upcoming election have focused attention on the issue of protections for people with pre-existing conditions. While the focus has been on the ACA’s private insurance protections, Medicaid also plays… Read More »Medicaid Covers People with Pre-Existing Conditions, Too
This data note looks at national and state-by-state Medicaid and CHIP preliminary enrollment data through June 2020, as states were still in the early stages of experiencing the health and economic effects of the coronavirus pandemic. After declines in enrollment from 2017 through 2019, preliminary… Read More »Analysis of Recent National Trends in Medicaid and CHIP Enrollment
Proposed change to Medicaid line extension definition ignores importance of critical improvements in treatments
In comments recently submitted to the administration, PhRMA raised concerns with a number of changes included in the Centers for Medicare & Medicaid Services (CMS) Medicaid proposed rule. Today, we’re diving deeper into CMS’s proposal to vastly expand the types of medicines that would fall… Read More »Proposed change to Medicaid line extension definition ignores importance of critical improvements in treatments
U.S. Supreme Court decisions shape health policy in important ways. The nomination of Judge Amy Coney Barrett, if confirmed, is expected to establish a solid 6:3 conservative majority that could affect case outcomes in several areas. This issue brief considers the potential implications of a… Read More »A Reconfigured U.S. Supreme Court: Implications for Health Policy
What You Should Know: – Innovaccer unveils new risk adjustment solution to help providers better segment their population to refine the risk scoring process and improve coding accuracy and efficiency, thereby improving performance on risk-based contracts. – The solution utilizes Artificial Intelligence (AI) and Natural… Read More »Innovaccer Unveils Risk Adjustment Solution For Improved Coding Accuracy
The Affordable Care Act, facing its first test during a deep recession, is providing a refuge for some — but by no means all — people who have lost health coverage as the economy has been battered by the coronavirus pandemic. New studies, from both… Read More »Refuge in the Storm? ACA’s Role as Safety Net Is Tested by COVID Recession
What’s the Latest on Prescription Drug Proposals from the Trump Administration, Congress, and the Biden Campaign?
This slideshow explains the similarities and differences among major proposals to lower prescription drug costs introduced by the Trump Administration, members of Congress, and the Biden campaign.
This side-by-side comparison examines President Trump’s record and former Vice President Biden’s positions across a wide range of key health issues, including the response to the pandemic, the Affordable Care Act marketplace, Medicaid, Medicare, drug prices, reproductive health, mental health and opioids, immigration and health… Read More »Health Care and the 2020 Presidential Election
Victor Siclovan, Director of Medicaid Transformation Project at AVIA Living through a pandemic is stressful and anxiety-inducing. Stay-at-home measures are compounding this stress, resulting in social isolation and unprecedented economic hardship, including mass layoffs and loss of health coverage. Fully understanding the impact of these… Read More »Digital Behavioral Health: Addressing The COVID-19 Behavioral Health Crisis
DENVER — D.j. Mattern had her Type 1 diabetes under control until COVID’s economic upheaval cost her husband his hotel maintenance job and their health coverage. The 42-year-old Denver woman suddenly faced insulin’s exorbitant list price — anywhere from $125 to $450 per vial —… Read More »Not Pandemic-Proof: Insulin Copay Caps Fall Short, Fueling Underground Exchanges
What You Should Know: – Molina Healthcare acquires New York-based Medicaid managed care organization Affinity Health Plan for $330M in cash serving members in New York City, Westchester, Orange, Nassau, Suffolk, and Rockland counties. – As of August 31, 2020, Affinity served approximately 284,000 Medicaid… Read More »Molina Healthcare Acquires Affinity Health Plan for $380M
What You Should Know: – NovuHealth and Revel merge to bring together NovuHealth’s personalized healthcare loyalty programs with Revel’s applied behavioral research and health action technologies. – Together, Revel and NovuHealth work with more than 50 healthcare organizations, including seven of the top 10 largest… Read More »Revel, NovuHealth Merge to Create Largest Healthcare Member Engagement Platform
Andy Aroditis, CEO, NextGate The COVID-19 pandemic is not just a medical crisis. Since the highly contagious disease hit American shores in early 2020, the virus has dramatically changed all sectors of society, negatively impacting everything from food supply chains and sporting events to the… Read More »Accounting for the Social Determinants of Health During the COVID-19 Pandemic
Molina announced it will acquire the assets of Affinity Health Plan, a New York-based Medicaid managed care organization. It’s one of several Medicaid MCO purchases the insurer has announced this year.
Finding previously unidentified insurance coverage can feel a little like a game of hide and seek. Patients may not always be aware of their insurance or eligibility for Medicare and Medicaid, and, in an effort to both improve the patient financial experience and simultaneously improve… Read More »Finding unidentified coverage without a Social Security Number (SSN)
Earlier this month, the Congressional Budget Office (CBO) gave an update to its federal budget projections between 2020 and 2030. As expected, things look grim for 2020. CBO projects a federal budget deficit of $3.3 trillion in 2020, more than triple the shortfall recorded in… Read More »CBO: COVID-19’s impact on the federal budget
While all eyes and ears are focused on COVID-19 and beating this pandemic, the administration has pursued harmful policy changes that we can’t let slip under the radar. In two back-to-back regulatory actions in recent months, the administration has taken steps to make it harder… Read More »Recent administration actions undermine patient assistance programs
As the COVID-19 pandemic continues, states have taken a number of Medicaid policy actions to address the impact on seniors and people with disabilities, many of whom rely on long-term services and supports (LTSS) to meet daily needs and are at increased risk of adverse… Read More »State Actions to Sustain Medicaid Long-Term Services and Supports During COVID-19
This data note looks at national and state-by-state Medicaid and CHIP preliminary enrollment data through May 2020, as states were still in the early stages of experiencing the health and economic effects of the coronavirus pandemic. Data show that after declines in enrollment from December… Read More »Analysis of Recent National Trends in Medicaid and CHIP Enrollment
The Trump administration’s latest effort to use COVID-19 rapid tests — touted by one senior official as a “turning point” in arresting the coronavirus’s spread within nursing homes — is running into roadblocks likely to limit how widely they’ll be used. Federal officials are distributing… Read More »Trump Is Sending Fast, Cheap COVID Tests to Nursing Homes — But There’s a Hitch
In a near-empty arena on the river in his hometown of Wilmington, Delaware, former Vice President Joe Biden accepted the Democratic nomination for president, promising hope over fear, fairness over privilege, love over hate. And, he said, “Facts over fiction.” Let’s see about that. Our… Read More »Democratic Convention, Night 4: ‘Facts Over Fiction’ in Biden’s Speech
Manufacturer cost-sharing assistance programs can save chronically ill patients hundreds to thousands of dollars annually
A recent analysis by IQVIA shows that chronically ill patients who used manufacturer cost-sharing assistance in 2019 saved hundreds to thousands of dollars on their out-of-pocket costs. IQVIA found that nearly one-third of commercially insured patients taking brand anticoagulants, diabetes or oncology medicines used manufacturer… Read More »Manufacturer cost-sharing assistance programs can save chronically ill patients hundreds to thousands of dollars annually
Food Insecurity and Health: Addressing Food Needs for Medicaid Enrollees as Part of COVID-19 Response Efforts
This brief provides an overview of food insecurity among Medicaid enrollees during the COVID-19 pandemic, examines participation in federal nutrition assistance programs by Medicaid enrollees, and identifies potential actions to address food insecurity among Medicaid enrollees as needs grow in response to the COVID-19 pandemic.
Addus HomeCare Corporation (Nasdaq: ADUS) is rebounding from coronavirus-related disruption in its personal care and home health segments, company leadership noted Tuesday during a second-quarter earnings call. But the Frisco, Texas-based company also acknowledged there are still significant challenges on the horizon. “Addus had a… Read More »Addus COO: Recruiting Has Been ‘a Little Bit of a Struggle’ During COVID-19
Irv Lichtenwald, President & CEO of Medsphere Systems Corporation In the late 1940s, the United Kingdom was busily reassembling country and what remained of the empire in the aftermath of World War II. Among many revelations, the war had convinced Britain’s leaders of the need… Read More »COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever
Can’t see the audio player? Click here to listen on SoundCloud. President Donald Trump keeps promising to unveil a comprehensive plan to replace the Affordable Care Act, but it keeps not appearing. However, this week he did order an expansion of telehealth for Medicare beneficiaries and… Read More »KHN’s ‘What the Health?’: Still Waiting for That Trump Health Plan
These state fact sheets offer a snapshot of the administration and delivery of Medicaid pharmacy benefits in each state.
Despite strong opposition from Republicans and rural voters, Missouri on Tuesday joined 37 states and the District of Columbia in expanding its Medicaid program. Voters in Missouri approved creating a state constitutional amendment that will open Medicaid eligibility to include healthy adults starting July 1,… Read More »Missouri Voters Approve Medicaid Expansion Despite GOP Resistance
The COVID-19 pandemic has led to renewed interest among policymakers, the media, residents, and their families in nursing home regulation and oversight, as residents and staff are at increased risk of infection due to the highly transmissible nature of the coronavirus, the congregate nature of… Read More »Key Questions About Nursing Home Regulation and Oversight in the Wake of COVID-19
Telehealth has quickly transformed the healthcare industry. Rather than scheduling an appointment, waiting up to a few weeks, and going to a doctor’s office or another healthcare facility, we can now access many types of care from the convenience of our smartphones. However, telehealth has… Read More »Telehealth and COVID-19: Overcoming New Challenges for Providers and Payers
As states and cities shatter their old coronavirus records due to the current summer resurgence, health care officials and policymakers are once again shining a spotlight on high-risk populations, which include older adults in the community, individuals living in long-term care facilities and the immunocompromised.… Read More »‘Family CNA Model’ for Pediatric Home Health Patients Gaining Momentum Amid COVID-19
ST. LOUIS — Haley Organ thought she had everything figured out. After graduating from a small private college just outside Boston, she earned her master’s degree, entered the workforce and eventually landed a corporate job here as a data analyst. Life seemed to be going… Read More »Missourians to Vote on Medicaid Expansion as Crisis Leaves Millions Without Insurance
When Will Lightbourne looked at the statistics behind California’s coronavirus cases, the disparities were “blindingly clear”: Blacks and Latinos are dying at higher rates than most other Californians. As of Monday, Latinos account for 45.6% of coronavirus deaths in a state where they make up… Read More »Medi-Cal Agency’s New Head Wants to Tackle Disparities and Racism
As reported by Kaiser Health News: Reversing a three-year decline, the number of people covered by Medicaid nationwide rose markedly this spring as the impact of the recession caused by the outbreak of COVID-19 began to take hold.Yet, the growth in participation in the state-federal… Read More »Medicaid enrollment on the rise
What You Should Know: – W2O announced today the acquisition of Discern Health, a leading healthcare consultancy based in Washington, DC, and Baltimore, to strengthen its strategic capabilities in assisting clients with critical healthcare policy trends and value-based reimbursement models. – Discern Health brings experts with… Read More »W2O Acquires Discern Health to Strengthen Value-Based Care Capabilities
Steve Alvarez started feeling sick around Father’s Day weekend this year. His symptoms started as mild, but developed into a fever, chills and shortness of breath he couldn’t shake. “Just when I started to get to feeling better and I would have a couple of… Read More »In Texas, More People Are Losing Their Health Insurance as COVID Cases Climb
In a speech this month, former Vice President Joe Biden, the presumptive Democratic presidential nominee, offered the third installment of a four-part economic plan being rolled out in advance of the Democratic National Convention in August. This set of proposals focused on caregivers — whether for… Read More »Biden Is Right. Pay for Home Health Workers Is Paltry.
Reversing a three-year decline, the number of people covered by Medicaid nationwide rose markedly this spring as the impact of the recession caused by the outbreak of COVID-19 began to take hold. Yet, the growth in participation in the state-federal health insurance program for low-income… Read More »The COVID-19 Downturn Triggers Jump in Medicaid Enrollment
Jay Desai, CEO & Co-Founder, PatientPing As COVID-19 continues to impact the country, providers across the continuum face new challenges delivering care and ensuring safety for their patients and themselves. During this period, sharing real-time information about patients’ care encounters across provider types and care… Read More »How ADT-Based E-Notifications Can Enable Better Safety for COVID-19 Patients
This data note looks at national and state-by-state Medicaid and CHIP enrollment data through April 2020, as states were beginning to experience the health and economic effects of the coronavirus pandemic.
The predictions were dire: Coronavirus lockdowns would put millions of Americans out of work, stripping them of their health insurance and pushing them into Medicaid, the health insurance program for low-income people. In California, Gov. Gavin Newsom’s administration projected that the pandemic would force about… Read More »Medicaid Mystery: Millions of Enrollees Haven’t Materialized in California
Temporary Enhanced Federal Medicaid Funding Can Soften the Economic Blow of the COVID-19 Pandemic on States, but is Unlikely to Fully Offset State Revenue Declines or Forestall Budget Shortfalls
The temporary boost in federal Medicaid funding enacted as part of the Families First Coronavirus Response Act (FFCRA) will soften the economic blow of COVID-19 on states, but is unlikely to fully offset state revenue declines or forestall budget shortfalls stemming from the pandemic, finds… Read More »Temporary Enhanced Federal Medicaid Funding Can Soften the Economic Blow of the COVID-19 Pandemic on States, but is Unlikely to Fully Offset State Revenue Declines or Forestall Budget Shortfalls
This brief examines how much fiscal relief states can expect from the increase in the Medicaid FMAP under FFCRA under different assumptions about the duration of the relief, how the FMAP increase provides broad fiscal relief to states and the factors that affect how much… Read More »How Much Fiscal Relief Can States Expect From the Temporary Increase in the Medicaid FMAP?
Senior care — an increasingly important topic that’s too often overlooked on the campaign trail — is back in the spotlight. And maybe this time it will have some staying power. Presumptive Democratic presidential nominee Joe Biden has floated a sweeping new 10-year plan that… Read More »Biden Announces $775B Plan to Boost the Caregiver Economy, Support In-Home Care Providers
LTC cases in hotspot states are increasing at 4x the rate as LTC cases in non-hotspot states. Media has largely focused on the share of cases attributed to a younger population. However, increased cases in long-term care facilities are cause for concern, given that nearly… Read More »Rising Cases in Long-term Care Facilities Are Cause for Concern
Molina will acquire Passport Health Plan’s Medicaid and dual-eligible business for $20 million. The Kentucky-based company is a long-standing provider of Medicaid managed care plans, but lost a bid with the state earlier this year.
This data note looks at state Medicaid managed care enrollment data from March 2019 and March 2020 as well as managed care enrollment data obtained from state websites for April and May 2020, to help begin to assess the impact of the COVID-19 pandemic and… Read More »Data Note: Growth in Medicaid MCO Enrollment during the COVID-19 Pandemic
Many states are anticipating significantly higher Medicaid enrollment numbers for the remainder of 2020 and beyond as out-of-work Americans look to replace lost employer-sponsored health insurance. To prepare for this likely surge, Medicaid plans must take proactive steps to curtail inappropriate medical costs without sacrificing… Read More »Five critical areas of focus for Medicaid plans amid COVID-19
Researchers at the Urban Institute found that up to 10 million people could lose their job-based insurance due to Covid-19 by the end of the year.
This Medicaid waiver tracker page aggregates tracking information on pending and approved Section 1115 Medicaid waivers. It includes resources such as an overview map and figure, detailed waiver topic tables, and explanatory briefs.
What You Should Know: – 8 in 10 consumers said COVID-19 made telehealth “an indispensable part of the healthcare system, according to a new study commissioned by Change Healthcare. – 2020 Change Healthcare – Harris Poll Consumer Experience Index reveals 65% said they plan to… Read More »8 in 10 Consumers Stated COVID-19 Made Telehealth “Indispensable” in Healthcare Delivery
A network of community health centers in northern California quickly built out telehealth tools, mapping services and other technologies to respond to Covid-19. Leaders with two organizations shared how they did it.
The COVID-19 pandemic and resulting economic downturn are taking a toll on mental health for many Americans, with large shares of the public saying that related worry and stress is having a negative effect on their mental health. A new KFF analysis and series of… Read More »New State Fact Sheets Highlight Key Data About Mental Health and Substance Use Needs and Capacity
We Are in Store for the Greatest Change to Our Healthcare System Since the Affordable Care Act. Here’s Why.
By LOGAN CHO The COVID-19 pandemic has been harsher and lasted longer than many of us would have predicted. While our media has been inundated with updates on death tolls and economic depression, there has been little conversation of healthcare beyond the era of COVID-19.… Read More »We Are in Store for the Greatest Change to Our Healthcare System Since the Affordable Care Act. Here’s Why.
As a teenager, Paulina Castle struggled for years with suicidal thoughts. When her mental health was at its most fragile, she would isolate herself, spending days in her room alone. “That’s the exact thing that makes you feel significantly worse,” the 26-year-old Denver woman said.… Read More »Colorado, Like Other States, Trims Health Programs Amid Health Crisis
What You Should Know – Doctor On Demand raises $75M in Series D funding led by General Atlantic to expand comprehensive virtual care. – Doctor On Demand is seeing record usage this year – up 139% – for COVID-19 screenings, routine health issues, chronic conditions and behavioral health. San Francisco, CA-based Doctor… Read More »Doctor On Demand Raises $75M to Expand Comprehensive Virtual Care Platform
In response to COVID-19, all 50 states + DC are using emergency waivers and other authorities to make changes to their Medicaid programs. Check out details of these Medicaid emergency authorities on our tracker.
This page displays an interactive map of the current status of state decisions on the Affordable Care Act’s Medicaid expansion. Additional Medicaid expansion resources are listed (with links) below the map.